An epidemiological study on delay in treatment initiation of cancer patients

Abstract

Early diagnosis and timely initiation of treatment of cancer patients may improve survival and quality of life. Various measures of delay can be made during diagnosis and treatment initiation. Most of the studies were based on single type of cancer with different definitions and measurements of delay in diagnosis and treatment. Thus, it has been difficult to synthesize results and generalize to other types of cancer. The study proposes to measure total duration between onsets of symptom to start of treatment into three components, namely primary, secondary and tertiary delays. Primary delay is defined as onset of symptoms to contacting the first medical person, secondary delay is from first medical contact to confirmed diagnosis, and tertiary delay is from confirmed diagnosis to treatment initiation. The aim of this study is to determine factors associated with primary, secondary and tertiary delays in cancer patients. This study was planned as a cross-sectional study. Data was collected from patients admitted to the surgical wards of Department of Surgical Oncology, Institute Rotary Cancer Hospital, New Delhi during 2006-2007. Gamma regression and quantile regressions at 25th, 50th and 75th percentile of each of the delays were used to determine related factors. A total of 403 patients were included in the analysis. The median tertiary delay was found almost two folds (59; Interquartile range: 26 - 101 days) than the primary and secondary delays. Extremity cancer patients had longest primary, secondary and tertiary delays. Shortest primary, secondary and tertiary delays were observed for gastrointestinal cancer, breast and genitourinary cancer respectively. There is an urgent need and scope to reduce delay at each level primary, secondary and tertiary delay. Intervention studies are needed through information, education and communication/screening programs to reduce the diagnostic and treatment delays in cancer patients

Identifying Superior Parents and Recombinants in Rice (Oryza sativa L.) under Salt Affected Soil

“…The foregoing observation clearly indicated that there was no particular relationship between positive and significant sca effects of crosses with gca effects of their parents for the characters under study. Saleem et al, (2010), Saidaiah et al, (2011);Dwivedi and Pandey (2012); Sanghara and Hussain (2012) and Tiwari et al, (2014) have also reported similar findings. High × high, high × average and average × average crosses give transgressive segregants and selection in early generation would be advantageous for development of pure lines as there are involvement of additive gene action, whereas, crosses having high × low, average × low and low × low general combining parents are suggested for heterosis breeding as their inheritance are controlled by non-additive and epistatic gene action.…”

Characteristics of the Delayed or Refusal Therapy in Breast Cancer Patients: A Longitudinal Population-Based Study in Taiwan

“…Among them, the clinician delay belongs to secondary delay and tertiary delay. Delay in any phase or no treatment would cause cancer progression to advanced stages, and significantly affects the treatment outcome [ 44 , 45 ]. Phases and characteristics of delay or refusal of therapy are different among different cancers and stages.…”

“…Phases and characteristics of delay or refusal of therapy are different among different cancers and stages. For breast cancer, the major type of delay or no treatment was tertiary delay, and followed by primary delay[ 45 ]. Furthermore, phases of therapy delay also depend on region and country (cancer care system), patient characteristics, age as well as cancer staging.…”

Educational Levels and Delays in Start of Treatment for Head and Neck Cancers in North-East India

“…The main reason for primary delay in seeking treatment for oral cancers in Indian population was due to patients themselves (Joshi et al, 2014). Delays have been outlined by Dwivedi et al (2012). Primary delay is defined as the time from the onset of symptoms to first contact with medical persons, secondary delay is defined as the time from contacting the first medical per-son to a confirmed diagnosis and tertiary delay is defined as the time from…”